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Nontrucking/Bobtail Quote
Nontrucking/Bobtail Quote
Nicholas Slahta
2024-03-06T17:20:10-05:00
Step
1
of
7
14%
Did anyone refer you to us?
(Required)
Youtube
Customer Referral
Tiktok
Email Marketing
Facebook
Instagram
Organic/Search
Angry Pops Logistics
Big Rig Permit Services LLC
The Compass Circle Team
Agent
SDR
Google
Software Sign-up
PPC
Cold Call
Letter
Ad Signs
Facebook Ads
Agent Name
(Required)
Nicholas Slahta
Referral Source
(Required)
Youtube
Customer Referral
Tiktok
Email Marketing
Facebook
Instagram
Organic/Search
Angry Pops Logistics
Big Rig Permit Services LLC
The Compass Circle Team
Google
Software Sign-up
PPC
Cold Call
Letter
Ad Signs
Facebook Ads
Do you currently have a Bobtail / Non-Trucking policy?
(Required)
Yes
No
Do you want the policy written in your personal name or a business name?
(Required)
Personal Name
Business Name
If your truck is financed in your business name, you'll likely need to write the policy in the business name as well.
Business Name
(Required)
DBA Name
EIN/ Tax ID
Don't include the dash! Format: 123456789
Name
(Required)
First
Last
Date of Birth
(Required)
Month
1
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12
Day
1
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1920
Phone
(Required)
Please make sure you can answer this number if we need to call you. ***If you decide to change your number, make sure you let us know so we can update your account.
Email
(Required)
If you change your email address or add another address later, please let us know so we can communicate with you.
Home Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
This should match the address on the Owner's Driver's License.
Will you garage/park your vehicle at your home address when you are not on the road?
Yes
No - Parked at a different location
Garaging Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
What kind of truck do you run?
(Required)
Semi Truck
Box Truck
Hotshot
Dump Truck
Cargo Van
Mark all that apply!
Will you be renting any trucks?
(Required)
Yes
No
Which Rental Company will you be using?
(Required)
Budget
Penke
Ryder
Enterprise
Other
Furthest you will dead head on average? (Miles)
(Required)
50
100
200
300
500
Vehicle Info
VIN
Year
Make
Model
Do you need Physical Damage coverage?
(Required)
Yes
No
What is the current market value?
(Required)
Would you like a quote for an extended truck warranty?
(Required)
Yes
No
What is the current mileage for the truck?
(Required)
First Choice
Second Choice
Third Choice
Furthest you will dead head on average? (Miles)
(Required)
50
100
200
300
500
Marital Status
(Required)
Married
Single
Driver's License Number
Liscense State
(Required)
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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Hawaii
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New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Do you have a CDL?
(Required)
Yes
No
What year was the CDL issued?
(Required)
Have you completed an Accident Prevention Course in the past 3 years?
(Required)
Yes
No
Discounts
Do you currently have personal auto insurance?
(Required)
Yes
No
This is a HUGE discount so do not skip this if you have personal auto insurance!!!
What year did you incorporate your business?
Coverages
Bobtail / Non-Trucking Liability Limit
(Required)
$750,000
$1,000,000
Do you plan on getting your own Authority within the next 12 months?
(Required)
Yes
No
Commodities
(Required)
General Freight
Automobiles
Construction Materials (flatbed trailers)
Equipment (flatbed trailers)
Logs
Select all that apply
DOT# of Motor Carrier you will be leasing on to
Comments
Consent
(Required)
I agree
Most insurance companies use information from you and other sources, such as your driving, claims and credit histories, to calculate an accurate price for your insurance. New or updated information may be used to calculate your renewal premium. Each company's Privacy Policy explains how they disclose and protect your personal information and how you may access and correct it. I can provide a copy at your request. If selected, we may share your contact info with our affiliate partners.
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